Single-Payer Group Opposes Insurance Retail Clinics

byjuliaonMarch 16, 2009

Advocates of national, single-payer health insurance held a rally in downtown Pittsburgh, Pennsylvania, to protest the opening of the insurance retail stores that we discussed in our post, “Shopping for Care.”

Their problem with the retail stores?

From the group’s email: “Selling healthcare coverage is an affront to the concept of healthcare as a human right, which should be guaranteed to all and equal for all.”

A few weeks ago we reported on Highmark’s plans to open such stores in PA. Highmark’s CEO, Ken Melani, has said that the purpose of the stores is to help guide the purchaser through the insurance buying process. He also points out that there is a growing demand for such services as folks are now heading to the individual insurance market in greater numbers.

We were skeptical about the potential success of the insurance outlets before.

After all, similar healthcare retail clinics like MinuteClinic and CheckUps, have not done very well, despite offering low-cost services and convenient hours. While it was once predicted that there would be 6,000 of these clinics by 2012, they are now shutting their doors left and right instead.

But we are also concerned about the role that these types of market-driven initiatives are expected to play in reforming our healthcare system.

In the case of the retail clinics, experts hoped that the clinics could help uninsured and underinsured patients to access cheap, preventative care, while also working to drive down the price of services offered by private providers.

But in reality, the clinics were never able to build up a large enough market share to have any influence on private provider pricing.

And most uninsured Americans have never visited a retail clinic, so they are not benefiting from this “consumer choice.”

When it comes to the insurance outlets, the single-payer advocates raise a good point.

There are fundamental problems with the for-profit, individual insurance market that keep folks from accessing affordable, comprehensive care there.

As we showed in this As We See It piece on gender rating, for example, women are charged higher premiums than men for comparable plans on the individual market. And folks with pre-existing conditions are often denied coverage altogether, or they are charged exorbitant premiums that they simply cannot afford.

Insurance retail stores are not going to solve these access and affordability problems. They will just direct more people to the problematic private insurance market.

In other words, if we do want to make sure that all Americans have access to health care, we cannot simply rely on market-based plans, such as providing tax credits to uninsured Americans so that they can obtain coverage on their own.

Afterall, what good is a tax credit when you don’t have an income?

President Obama and Congress are hammering out the details of a national universal coverage initiative that would include a public sector health plan for uninsured Americans to buy into. More about the public sector option to come.

And single-payer advocates propose having a Medicare-like insurance program for all Americans. Under this plan, the government would finance insurance coverage and private hospitals, physicians and clinics would continue as private organizations to provide care.

One possible solution to the occasional lack of access to, or shortage of, primary care doctors is what are known as retail care clinics, or convenience care clinics.

The popularity of these clinics continues to increase progressively for a variety of reasons.

Of particular note is that most of these types of clinics is that are normally staffed with nurse practitioners or physician assistant. Both are health care providers and are actually favored by many as treatment providers progressively.

Surveys reveal that over half of all people prefer seeing a nurse practitioner at a convenience clinic because the visits do not take up so much of their time, as well as the visits being less expensive than traditional doctor visits.

The growth of such clinics, and the patient volume of each clinic, may slow at times, but the unique benefits of such urgent care light clinics do in fact exist and are desirable for many.

While the first retail clinic began in the year 2000, presently, there are over 700 of these convenience care clinics, and that number is speculated by some to increase to thousands within the next few years.

First, I’ll offer a definition of a retail clinic:

A retail clinic is a medical treatment facility that is usually located in a convenient location, such as a shopping area, and is smaller than most doctors’ offices in regards to geographical space. Again, these types of clinics are staffed with a physician assistant or nurse practitioner.

Both types of these health care providers have the ability and authority to provide the same quality care as a primary care physician, and do so with the same if not superior standards regarding accountability and autonomy.

If you happen to go to one for what may be considered a mild ailment, for example, for such conditions as allergies or the flu, you will notice a unique and pleasant experience regarding your medical care at such a clinic in comparison with many other doctor’s offices that often appear to be possibly demoralized if not largely apathetic, in regards to their disposition.

These urgent care light clinics are normally and amazingly quick for a patients who are medically treated at such locations. You as a patient are normally in and out of there within a half hour or so. This includes a thorough assessment and treatment regimen offered by the health care providers at such clinics.

Unlike typical doctor offices, these clinics are walk-in clinics, so there is no over-booking of patients, which is what typically occurs at current offices of doctors. Many are focused on the daily volume of patients for a variety of reasons.

With these convenience care clinics, you as a patient actually dialogue with your health care provider more so than you may have experienced in a traditional doctor’s office due to possibly other doctor offices often being incredibly busy from seeing too many patients during a typical day for reasons described above.

And this is not to imply that the health care providers at typical doctor offices do not care about you and your particular health issues, yet possibly is a result of having limited resources related to patient care.

As a result, they may be unable to do so.

The cost of going to such a retail clinic typically is about 25 percent less expensive than a normal doctor visit, others have said. Yet you will likely notice no decline in the quality of care that you receive.

In fact, likely you will experience greater quality on many different levels, both from a personal level and treatment level if a patient at such a clinic as a retail clinic, others have said.

Critics of such convenient care clinics include the American Medical Association, and various medical societies. Yet in my opinion, such critics may be simply vexed because of the invasion of these other clinics on their turf and their infiltration into their typical medical practice paradigm without being invited, perhaps.

Or maybe such groups and associations do not see NPs and PAs as having the ability to provide quality medical care as they do as medical doctors. Regardless, most patients seem pleased with the retail clinics and the treatment providers who care for them at these convenience care clinics.

If it is discovered that you need greater medical care or attention than the retail clinic can provide for you during your visit at a urgent care light clinic, you will most likely be referred to a nearby location that can provide the care you are determined to need by the clinic’s heath care provider.

The clinic’s health care provider likely has some familiarity as well as some relationships with the hospitals and others in the medical community for which they serve. It should be noted that both NPs and PAs are quite capable of determining the severity of your illness, and will act accordingly.

So most patients of these retail clinics are pleased with the care they receive from them, which is why such clinics continue to grow in number under different names, as they have become franchises, yet the concept of this ‘pay as you go’ health care is fairly new.

So only the future will tell if this method is preferred by those seeking minor restoration of their health. It seems to be preferred by many presently, once again. And presently, Take Care Health Clinics, owned and located inside Walgreen’s pharmacies, are the market leader with retail clinics. Walgreens plans to add more clinics next year.

These retail clinics are in a way a response to the shortage of PCPs that exist presently, and delays others experience in our health care system when they seek restoration of their health on occasion. In other words, retail clinics are quick when you are sick, yet quality and assessment of your medical condition are not compromised.

One could conclude that the retail clinics seem in a way more authentic than the dominant system, and may be more beneficial ultimately for the public health, with exceptions, of course, depending on the individual circumstances of the patient.